Medicine and Health Sciences Commons^™

Malignant Vascular Tumours Associatedwith The Breast: A Study Of 7 Cases, Azizun-Nisa, Zeeshanuddin, Naila Kayani

Department of Pathology and Laboratory Medicine

Angiosarcomas account for less than 0.05% of the malignant neoplasms of the breast. We present here 7 cases of malignant vascular neoplasms of the breast, including 2 cases of postmastectomy Stewart-Treves syndrome. In this case series, most of the patients were young. Tumour was bilateral at presentation in one case. The size of the tumours ranged from 1.6 cm to 11 cm. Although breast angiosarcomas are rare neoplasms, with the increasing use of radiation therapy for breast cancer patients, post-radiation skin lesions should not be ignored.

Conservative Management Of Invasive Cervical Resorption: A Case Report, Fahad Umer, Samira Adnan, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Abstract

Invasive cervical resorption is a condition that affects the root surface area below the epithelial attachment. Multiple treatment modalities are advocated, involving exposure of the invasive defect, removal of the granulation tissue and sealing with various restorative materials. This report demonstrates conservative treatment of a patient presenting with peri-apical periodontitis in upper right central and lateral incisors, along with Class II invasive resorption defect cervically on the mesial aspect of the central incisor, as a result of trauma. As the patient was not willing for any surgical intervention, only ortho-grade root canal treatment was carried out in both teeth, …

The Lived Experience Of Families With A Mentally Ill Family Member, Moses Wankiiri, Karen B. Drake, Kimberley R. Meyer

School of Nursing & Midwifery, East Africa

The study of the lived experience of families with a mentally ill family member involved seven family members who had come to visit their mentally ill relatives in the mental Hospital. The major objective was to explore the lived experience of families with a persistent1 mentally ill family member. The study adopted a qualitative descriptive-phenomenological design, participants were purposively sampled and data was collected using a tape recorder. Colaizzi’s phenomenological approach for data management was then employed. The study revealed that family members held misconceptions about mental illness
and described care as a contractual obligation. They lived in misery as …

Vulnerabilities, Health Needs And Predictors Of High-Risk Sexual Behaviour Among Female Adolescent Sex Workers In Kunming, China, Xu-Dong Zhang, Marleen Temmerman, Yan Li, Wei Luo, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objectives: This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed.

Methods: A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed.

Results: Adolescent …

Need For Multilevel Strategies And Enhanced Acceptance Of Contraceptive Use In Order To Combat The Spread Of Hiv/Aids In A Muslim Society: A Qualitative Study Of Young Adults In Urban Karachi, Pakistan, Syed Farid-Ul-Hasnain, Eva Johansson, Saleema A. Gulzar, Gunilla Krant

Community Health Sciences

This qualitative study explored knowledge, attitudes, beliefs and perceptions of sexual and reproductive health, focusing specifically on contraceptive use and HIV prevention among young unmarried men and women, 17-21 years, in urban Karachi, Pakistan. The main theme, identified as underlying meaning in the focus group discussions was "Societal norms and perceptions create barriers to knowledge and awareness about sexual and reproductive health matters among young adults". A knowledge gap was revealed concerning HIV/AIDS and contraceptive use among young males and females, who have to rely on media and peers for information seeking. Study participants perceived that HIV/AIDS is incurable and …

Heavily Thickened Pericardium With Constrictive Pericarditis., Abid Laghari, Javed Tai

Department of Medicine

A middle-aged male presented with symptoms of exertional shortness of breath and leg swelling for the past six months. Examination revealed raised jugular venous pressure (JVP), pitting pedal oedema, muffled heart sounds, bilateral pleural effusion and hepatomegaly. Echocardiogram showed features of constrictive pericarditis with heavily thickened pericardium, which was confirmed by cardiac computed tomography (CT). The patient underwent pericardiectomy following which echocardiographic features of constriction were reversed and the patient became asymptomatic.

Spontaneous Coronary Artery Dissection: A Rare Cause Of Acute Coronary Syndrome., Abid Laghari, Aamir Hameed, K. Kazmi

Department of Medicine

We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2 h duration. The examination revealed irregular pulse of 138 bpm, blood pressure 115/75 mm Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with β blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed …

My Patient Has Intracranial Stenosis, Does He Need An Intracerebral Stent? Results Of The Sammpris Study., Muhammad Faisal Wadiwala,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Medical Errors Related To Look-Alike And Sound-Alike Drugs, Samina Ismail,, Arshad Taqi

Department of Anaesthesia

Despite recent developments in the inventory management, introduction of electronic drug trolleys and cabinets, color coding of the filled syringes and many more interventions, medication errors could not be eliminated. The most common of these are syringe swap and human errors regarding wrong drug administration due to look-alike drug containers or sound-alike names of the drugs belonging to diverse groups. Many of the fatalities, that occur in third world countries due to these causes, go unnoticed and unregistered. This special article complements two special editorials on the same topic by Professor Joseph D. Tobias et al and Professor Robert Stoelting, …

Better Drug Therapy For The Children Of Africa: Current Impediments To Success And Potential Strategies For Improvement, Stuart M. Macleod, Janet K. Finch, William Macharia, Gabriel M. Anabwani

Paediatrics and Child Health, East Africa

A commentary is presented on the urgent need for a comprehensive effort to improve the practice of pediatric therapeutics in Africa. A call for action is addressed to a variety of practitioners internationally, many of whom possess skills that could be fruitfully applied to the improvement of health outcomes for African children. Successful engagement with the many challenges requires the complementary effort of researchers in basic and clinical pharmacology and toxicology, nurses, pharmacists, physicians, clinical pharmacologists, clinical pharmacists, and political leaders and civil servants. While a comprehensive or systematic review of the relevant literature has not been attempted, the authors …

Dementia Prevalence Estimates In Sub-Saharan Africa: Comparison Of Two Diagnostic Criteria, Stella Maria Paddick, Anna R. Longdon, Aloyce Kisoli, Catherine Dotchin, William K. Gray, Felicity Dewhurst, Paul Chaote, Raj Kalaria, Ahmed Jusabani, Richard Walker

Faculty of Health Sciences, East Africa

Background:

We have previously reported the prevalence of dementia in older adults living in the rural Hai district of Tanzania according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. The aim of this study was to compare prevalence rates using the DSM-IV criteria with those obtained using the 10/66 diagnostic criteria, which is specifically designed for use in low- and middle- income countries.

Methods:

In phase I, 1,198 people aged 70 and older were screened for dementia. A stratified sample of 296 was then clinically assessed for dementia according to the DSM-IV criteria. In addition, …

Impact Of Unplanned Excision On Prognosis Of Patients With Extremity Soft Tissue Sarcoma, Hafiz Muhammad Umer, Masood Umer, Irfan Qadir, Nadeem Abbasi, Nehal Masood

Section of Orthopaedic Surgery

Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and …

Single Stage Oncologic Resection And Reconstruction: A Step Toward Development Of Sarcoma Service In Resource Constrained Country, Haroon Ur Rashid, Kashif Abbas, Masood Umer

Section of Orthopaedic Surgery

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage.
Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific …

Asymptomatic Unilateral Cerebellar Hypoplasia In An Adult Patient - A Unique Presentation., Pari Gul, Bushra Rehan, Saleha Anwar, Ambreen Majeed, Ayub Mansoor

Pakistan Journal of Neurological Sciences (PJNS)

Unilateral cerebellar hypoplasia is a relatively rare malformation. We report a case of 54 year old female patient who presented with single episode of sudden unconsciousness and slurring of speech. Imaging finding suggests the diagnosis of unilateral cerebellar hypoplasia. The patient recovered with conservative management probably because the symptoms were due to Transient ischemic attack not due to hypoplasia.

Tacrolimus Induced Reversible Encephalopathy, Nirmal Surya, Devshi Visana

Pakistan Journal of Neurological Sciences (PJNS)

Tacrolimus is a novel immunosuppressant used to prevent graft rejection after allogenic organ transplantation. Serious neurological complications of tacrolimus are rare. We present a lady who developed confusion, paresthesiae and visual hallucinations while on tacrolimus following a renal transplant.Her tacrolimus level was high and she improved on stopping the drug. This case highlights the reversible encephalopathy induced by tacrolimus.

Efficacy Of Interferon In Multiple Sclerosis, Evangelos A, , Nikolaos Ch. Syrmos, Anastasios Orologas

Pakistan Journal of Neurological Sciences (PJNS)

Introduction of interferon b-1b in the therapeutic strategy against Multiple Sclerosis has resulted in a great amelioration of treatment in various terms. Relapse rates, delaying progression of the activity, improvement of imaging outcomes as well as reduction of disease activity itself consist great achievements against a pathological condition that challenged medical effectiveness throughout decades. Two recombinant human IFN-1a and an IFN-1b preparations have been proved effected and well tolerated. We reviewed the most important literature concerning pharmacodynamics, medical efficacy, tolerability and adverse effects of interferon-b usage. In parallel, despite the wide range of trials referring to INF-b treatment, we tried …

Compliance To Antipsychotic Medication: A Challenge For Client, Family And Health Care Providers., Ambreen Tharani, Salima Farooq, Faiza Saleem, Anila Naveed

School of Nursing & Midwifery

Compliance with anti-psychotic medications plays a significant role in managing clients with schizophrenia. It not only helps in controlling the symptoms, but also decreases the risk of relapses and ultimately improves quality of life (QoL) for the clients. However, compliance with anti-psychotic medication remains a challenge for the client, family and healthcare providers. Identification of these associated factors is vital to make appropriate plan to enhance medication compliance. In this paper, various factors are highlighted that are associated with medication compliance in clients with schizophrenia.

Performance And Measurement Of A Community-Based Distribution Model Of Family Planning Services In Pakistan, Syed Khurram Azmat, Shirin Ahmed, Waqas Hameed, Mohsina Bilgrami, Ayesha Khan, Adnan Ahmad Khan, Ghulam Mustafa

Community Health Sciences

Introduction: Community-based distribution (CBD) has been successfully applied to family planning (FP) services worldwide. It forms the basis for the large lady health worker (LHW) programme in Pakistan which serves a limited number of women with contraception services. Thus, the concept has seen limited application in Pakistan. We present the outcomes of a CBD model that was implemented in 49 districts across Pakistan by a non-government organization (NGO).
Methods: The Marie Stopes Society (MSS) developed a CBD model around its fixed centres and reached around half a million married women of reproductive age (MWRA) with services. The services provided included …

Social Franchising And Vouchers To Promote Long-Term Methods Of Family Planning In Rural Pakistan: A Qualitative Stocktaking With Stakeholders, Syed Khurram Azmat, Ghulam Mustafa, Waqas Hameed, Jamshaid Asghar, Aftab Ahmed, Babar T. Shaikh

Community Health Sciences

Background: The overall use of modern contraception in Pakistan is quite low, especially in rural areas. Several studies have demonstrated the effectiveness of social franchising (SF) approaches in increasing access to modern contraception and improving the quality of healthcare in resource-poor areas in Asia and Africa. Drawing on best practices in SF, the Marie Stopes Society (MSS) implemented an SF model in certain rural areas of Pakistan to increase access to affordable and quality family planning (FP) services. The model was branded as Suraj (sun) and complemented with an innovative voucher scheme for intrauterine contraceptive devices (IUCDs). This paper describes …

Clinical Profile And Outcome Of Children Admitted With Status Epileptics In Picu Of A Developing Country, Khalid Ahmed, Sidra Kaleem Jafr, Faria Bhatti, Arshad Rafique, Anwa Rul Haque Haque

Pakistan Journal of Neurological Sciences (PJNS)

Status epilepticus (SE) is a common, life-threatening neurologic disorder. The exact incidence is not known. The frequency of occurrence of status epilepticus is 17-23 per 100, 000 persons per year, with the higher incidences occurring in developing countries. In children the mortality from SE ranges from 3-10%.

Objective: To describe the etiology, clinical profile and immediate-outcome of children with status epilepticus at a Tertiary Care Hospital in Karachi.

Epilepsy: The Pakistan Perspective Some Suggestions, Fowzia Siddiqi

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is a disease that affects more than 65 million people around the world. In Pakistan prevalence of epilepsy is 9.99/1000 people, thus around 2million people in Pakistan suffering from epilepsy^1,2.The prevalence in children is much higher 14.6/1000^3,4,5.Prof. Charles Newton in the lancet quotes 50,000 deaths from epilepsy annually in the US⁶. The death rate in the developing countries is much higher. The exact figures are difficult to assess due to lack of epidemiological surveys and incomplete data collection. However it is thought that the number will be greater and considered at least twice …

Abstracts From The 7th Annual Neurology Research Day, Shifa International Hospital, Islamabad, Syed Hussain Shah, Noreen Akhtar, Akhtar Waheed, Nida Fatima

Pakistan Journal of Neurological Sciences (PJNS)

:It's a cross sectional study conducted at CP clinic of Armed Forces institute of Rehabilitation medicine Rawalpindi from Jan 2012 to Jan 2013. All cerebral palsy children above 2 years of age and both genders were included in study. SPSS version 17 was used for data analysis.

Hepatocellular Carcinoma In Native South Asian Pakistani Population; Trends, Clinico-Pathological Characteristics & Differences In Viral Marker Negative & Viral-Hepatocellular Carcinoma, Amna Subhan Butt1, Saeed Hamid, Ashfaq Ahmad Wadalawala, Mariam Ghufran, Ammar Asrar Javed, Omer Farooq, Bilal Ahmed, Tanveer Ul Haq, Wasim Jafri

Section of Gastroenterology

Background

HCC is the fifth most common cancer globally. Our study was conducted to (1)investigate the trends and clinico-pathological characteristics of Hepatocellular carcinoma among native South Asian patients in Pakistan, (2)to estimate the prevalence as well as the trends of viral marker negative HCC and (3) to compare the clinico-pathological, radiological characteristics, applicability of treatment at diagnosis and prognostic factors among patients with both viral marker negative and viral marker positive-HCC being consulted at Aga Khan University Hospital(AKUH), Karachi, Pakistan.

Method

Patients ≥18 years, already diagnosed to have HCC and visiting AKUH during 1999–2009 were identified using ICD code 1550. …

Coital Frequency And Condom Use In Monogamous And Concurrent Sexual Relationships In Cape Town, South Africa, Wim Delva, Fei Meng, Roxanne Beauclair, Nele Deprez, Marleen Temmerman, Alex Welte, Niel Hens

Obstetrics and Gynaecology, East Africa

Introduction: A decreased frequency of unprotected sex during episodes of concurrent relationships may dramatically reduce the role of concurrency in accelerating the spread of HIV. Such a decrease could be the result of coital dilution - the reduction in per-partner coital frequency from additional partners - and/or increased condom use during concurrency. To study the effect of concurrency on the frequency of unprotected sex, we examined sexual behaviour data from three communities with high HIV prevalence around Cape Town, South Africa.

Methods: We conducted a cross-sectional survey from June 2011 to February 2012 using audio computer-assisted self-interviewing to reconstruct one-year …

Prostate Specific Antigen As A Risk Factor For Skeletal Metastases In Black African Men With Prostate Cancer, Ayman Mahmood Qureshi

Master of Medicine in Imaging and Diagnostic Radiology

Background: Prostate cancer is one of the commonest cancers in men worldwide. Several recognised risk factors are associated with this disease, amongst them, race. Despite this, there is a paucity of data in the native African setting. The skeletal system is a common site of metastasis, its incidence increasing with increase in prostate specific antigen (PSA) levels. Bone scans are used to detect skeletal metastases. Its use in prostate cancer patients with abnormal but low PSA has been subject of debate. Objectives: To test the association of PSA levels with skeletal metastasis in men with histologically proven prostate cancer. Methodology: …

Interventions To Reduce Neonatal Mortality From Neonatal Tetanus In Low And Middle Income Countries - A Systematic Review, Adeel Ahmed Khan, Aysha Zahidie, F. Rabbani

Community Health Sciences

Background

In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting.

Methods

We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total …

Cerebral Sinus Thrombosis Secondary To Epidural Anaesthesia, Modar Khalil, Mohamed El-Sayed, Fayyaz Ahmed, Alec Ming

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous sinus thrombosis (CVST) is an uncommon, and yet potentially fatal, condition; we present a rare case of CVST as a complication of epidural anaesthesia used for caesarean section, we review different aspects

of CVST in terms of epidemiology, aetiology, investigations, and treatment, as well as most acceptable theory explaining the pathogenesis in our case report

Lasik In Hyperopic Eyes With Congenital Nystagmus: A Case Report, Sharmeen Akram, Zarksis H, Khabir Ahmad

Department of Surgery Docs

Patients with nystagmus are considered to be poor candidates for laser in situ keratomileusis (LASIK), because they are unable to fixate. This case report presents the first reported use of LASIK surgery with a solid-state laser in hypermetropia and congenital nystagmus. A 23 year old woman with congenital nystagmus had LASIK surgery to correct a refractive error of +2.25/+1.75 90º in the right eye and + 2.00 / +1.75 90º in the left one. Baseline uncorrected visual acuity (UCVA) was 20/200 in both eyes, and best spectacle corrected visual acuity was 20/40 in both the eyes. The procedure was performed …

Perceived Relative Factors Influencing Nurses’ Practice Of Health Promotion For Women In Calabar, Cross River State, Nigeria, E. Samson-Akpan, O. B. Edet, I. I. Akpabio, Ekaete Asuquo

School of Nursing & Midwifery, East Africa

Socio-cultural factors negate the health of women. Therefore, health promotion as a focus of nursing practice aimed at capitalizing on the inherent capacities of women to establish health priorities, goals and strategies to improve their health. A descriptive survey with the purpose of ascertaining the influence of culture, social and health policies on nurses’ practice of health promotion was undertaken. Three hypotheses were formulated to guide the study. A sample of one hundred and thirty six nurses participated in the study. A validated questionnaire with a test-retest reliability coefficient (r) of 0.79 was used for data collection. Correlation analysis was …

Major Incidents In Kenya: The Case For Emergency Services Development And Training, Benjamin Wachira, Wayne Smith

Internal Medicine, East Africa

Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in …